Das Antiphospholipid-Syndrom – Eine interdisziplinäre Herausforderung

Zusammenfassung

Das Antiphospholipid-Syndrom (APS) ist eine systemische Autoimmunerkrankung, die durch arterielle und venöse Thrombosen und/oder Schwangerschaftskomplikationen in Form von Spontanaborten und/oder Fehlgeburten definiert ist. Laboranalytisch ist das APS gekennzeichnet durch den Nachweis von Antiphospholipid-Antikörpern oder einem Lupus Antikoagulans. Antiphospholipid-Antikörper repräsentieren eine heterogene Gruppe von Autoantikörpern gerichtet gegen Phospholipid-Protein-Komplexe. Lupus Antikoagulanzien stellen eine gerinnungsaktive Untergruppe dar, in der Antikörper zu einer Verlängerung von phospholipidabhängigen Gerinnungstesten führen. Die Behandlung erfolgt individualisiert und richtet sich nach dem klinischen Verlauf. Nach venösen und arteriellen Ereignissen wird in der Regel eine langfristige orale Antikoagulation durchgeführt, eine Primärprophylaxe erfolgt nicht. Eine Abortprophylaxe erfolgt mit niedermolekularem Heparin in Kombination mit Aspirin.

Abstract

Antiphospholipid syndrome (APS) is a systemic autoimmune disease defined by venous or arterial thrombosis and/or pregnancy complications in the form of spontaneous abortions and/or recurrent fetal loss. Characteristic laboratory abnormalities in APS include persistently elevated levels of antibodies directed against membrane anionic phospholipids or their associated plasma proteins. Subgroups of these antibodies, called lupus anticoagulants, react with phospholipids in vitro, resulting in a prolongation of clotting time. In general, treatment regimens for APS must be individualised according to the patient's current clinical status and history of thrombotic events. After venous or arterial thrombosis, oral anticoagulation is recommended. Asymptomatic individuals with antiphospholipid antibodies do not require specific treatment. Treatment of pregnant patients with a history of recurrent fetal loss includes low-molecular-weight heparin and aspirin.

Schlüsselwörter

Antiphospholipid-Syndrom - Antiphospholipid-Antikörper - Lupus Antikoagulans - Thrombose - Abortneigung

Key words

Antiphospholipid syndrome - Antiphospholipid antibodies - Lupus anticoagulant - Thrombosis - Fetal loss

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